Introduction: Social determinants of health (SDoH) are the factors that affect a patient’s health quality and outcomes and contribute to health disparities. Evidence suggests that clinical care contributes only 20% to patients’ health outcomes, while the remainder is under the influence of upstream factors. The upstream approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream. Several SDoH may contribute to outcomes for cancer patients. This Upstream Gynecologic Oncology Initiative seeks to identify which SDoH affect a population of patients with gynecologic malignancies. Hypothesis: This study hypothesizes that women receiving care for gynecologic malignancies are affected by specific SDoH among the categories of housing, food, transportation, finances, health literacy and social support. This study aims to identify the frequency of these six social factors among the outpatient gynecologic oncology population at the University of Iowa. Methods: This needs assessment is the first phase in a quality improvement project assessing the SDoH affecting women with gynecologic cancers. Two hundred twenty-two patients receiving outpatient care for gynecologic malignancies completed an anonymous needs assessment survey. Validated survey questions regarding housing, food, transportation, finances, health literacy and social support were used to identify needs. Responses were considered positive if any degree of need was reported. Results: Responses demonstrated the most substantial need in the categories of social support (32%), health literacy (28%) and financial stability (24%). Less need was reported in the categories of food (11%), transportation (5%) and housing (4%). Fifty-seven percent of women reported at least one social need among the six categories screened. Conclusion: Upstream SDoH, most notably social support, health literacy and financial stability are identified to be present and likely contributing to health quality, outcomes, and disparities within this gynecologic oncology patient population. Overall, these findings support the idea that SDoH should be assessed for each unique patient population - and for each patient receiving care for gynecologic cancer. While social support was the most frequently reported SDoH, many patients already received adequate help at home; suggesting that meaningful efforts should next be directed at improving health literacy in the population. Appreciation and assessment of SDoH potential to impact care and management should be used to design a routine screening tool for the study population and organize resources to address or mitigate the identified needs.

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Background: Vulvovaginal irritation is a common gynecologic complaint. A number of factors may lead to a trial of therapy without undertaking a physical exam or diagnostic testing.

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INTRODUCTION: Food insecurity, a social determinant of health defined as limited availability of and access to adequate food, may heighten risks for poor pregnancy outcomes particularly if compounded by existing co-morbidities in high-risk pregnancies. The Upstream Obstetrical Clinic is a quality improvement project that seeks to address food insecurity in high-risk obstetrics patients. This study aims to identify the prevalence and impact of food insecurity among pregnant patients in the clinic population. METHODS: This project was deemed IRB-exempt by the HSRD. Validated survey questions regarding food insecurity were administered to high-risk obstetrics patients. Screen positive individuals were offered counseling by a team member to identify nutrition resources in the patient's residential area. Data collected were used to assess prevalence of social needs, correlation of social needs with co-morbidities, and effects on pregnancy outcomes. RESULTS: One hundred eighty-five women completed the survey, with 24% (44/185) screening positive. Diabetes was the most prevalent co-morbidity for screen positive patients (25/44, 57%). Twenty-two percent of screen positive, delivered patients were affected by diabetes (9/40). The prevalence of abnormal HgbA1C was 66% (6/9) among these patients. There was no difference in perinatal outcomes between patient subgroups. CONCLUSION: Twenty-four percent of all patients and 22% of diabetic patients identified as food insecure. Statistical differences could not be assessed due to limited sample size. Nevertheless, these results suggest that food insecurity may be associated with adverse health outcomes. As the Upstream Clinic population increases, the impact of food insecurity on obstetric and neonatal outcomes will continue to be assessed.